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Category 8 - MISCELLANEOUS SERVICES

10958

10958 - Additional Information

Item Start Date:
01-Jul-2004
Description Start Date:
01-Oct-2017
Schedule Fee Start Date:
01-Nov-2012

Group
M3 - Allied Health Services

OCCUPATIONAL THERAPY

Occupational therapy health service provided to a person by an eligible occupational therapist if:

(a)    the service is provided to a person who has:

  1. a chronic condition; and
  2. complex care needs being managed by a medical practitioner (including a general practitioner, but not a specialist or consultant physician) under a shared care plan or under both a GP Management Plan and Team Care Arrangements or, if the person is a resident of an aged care facility, the person's medical practitioner has contributed to a multidisciplinary care plan; and

(b)    the service is recommended in the person's Team Care Arrangements, multidisciplinary care plan or shared care plan as part of the management of the person's chronic condition and complex care needs; and

(c)    the person is referred to the eligible occupational therapist by the medical practitioner using a referral form that has been issued by the Department or a referral form that contains all the components of the form issued by the Department; and

(d)    the person is not an admitted patient of a hospital; and

(e)    the service is provided to the person individually and in person; and

(f)    the service is of at least 20 minutes duration; and

(g)    after the service, the eligible occupational therapist gives a written report to the referring medical practitioner mentioned in paragraph (c):

    (i) if the service is the only service under the referral - in relation to that service; or

    (ii) if the service is the first or the last service under the referral - in relation to that service; or

    (iii) if neither subparagraph (i) nor (ii) applies but the service involves matters that the referring medical practitioner would reasonably expect to be informed of - in relation to those matters; and

(h)    for a service for which a private health insurance benefit is payable - the person who incurred the medical expenses for the service has elected to claim the Medicare benefit for the service, and not the private health insurance benefit;

- to a maximum of  five services (including any services to which items 10950 to 10970 apply) in a calendar year



Fee: $62.25 Benefit: 85% = $52.95

(See para MN.3.1, MN.3.2, MN.3.3, MN.3.4, MN.3.5 of explanatory notes to this Category)


Extended Medicare Safety Net Cap: $186.75

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Legend

  • Assist - Addition/Deletion of (Assist.)
  • Amend - Amended Description
  • Anaes - Anaesthetic Values Amended
  • Emsn - EMSN Change
  • Fee - Fee Amended
  • Renum - Item Number Change (renumbered)
  • New - New Item
  • NewMin - New Item (previous Ministerial Determination)
  • Qfe - QFE Change